Epidural Steroid Injections – Lumbar, Thoracic, and Cervical
What Is the Epidural Space?
It is the space between the spinal sac membrane called the dura (which contains the spinal cord, nerves and fluid) and the epidural ligament, better known as the ligamentum flavum. It contains fatty tissue, blood vessels and it surrounds the nerves, as they exit the spinal column. The epidural space starts at the base of the neck and ends in the sacral canal.
What Is an Epidural Steroid Injection?
It is a procedure in which a specific steroid (which is a potent anti inflammatory medication) is injected in the epidural space in order to decrease inflammation around the nerves and discs, located in the cervical, thoracic and lumbo-sacral area. By reducing the inflammation, it allows the nerve to recover from the injury. The duration of pain relief will vary according to the specific condition being treated. The relief can be permanent or can last from days to months.
What Are the Indications for an Epidural Steroid Injection?
Although there are many conditions, which can potentially benefit from an ESI, the most frequent indication is nerve pain cause by either disc compression or bony canal irritation. This condition is known as radiculitis or radiculopathy. It is usually associated with arm, neck, back or leg pain (commonly referred to as sciatica). Other conditions such as spinal stenosis, low back pain from a herniated disc and other less frequent conditions such as shingles, may respond to epidural steroid injections.
Usually the procedure is performed under local anesthetic alone. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your neck, upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray machine, which provides constant imaging (called fluoroscopy) the specific area to be injected, will be identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert an epidural needle into the appropriate epidural space under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Following this, a solution of local anesthetic and steroid will be injected in the epidural space.
After the Procedure
You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. When indicated, you will be given a post procedure evaluation form to assess the effectiveness of the injections. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.
If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.